title: A patient with recent chest discomfort-ischemia or no ischemia? Postsystolic shortening comes to the rescue.
abstract: The diagnosis of myocardial ischemia in the emergency department can be challenging particularly in a patient in whom the chest discomfort has abated. Symptoms can be atypical, physical exam is often noncontributory, the electrocardiogram is usually nondiagnostic and cardiac enzymes remain normal. Thus, the decision for hospital admission or discharge can be quite difficult. Here, we describe such a patient in whom echocardiography with strain imaging identified the presence of postsystolic shortening (PSS) at the left ventricular apex. This suggested the likelihood of ischemic memory in the territory of the left anterior descending (LAD) artery. At coronary angiography a high grade stenosis was present in the proximal LAD artery. Our report highlights the role of echocardiography in the detection of myocardial ischemia and apical PSS as a marker of ischemic memory.
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Bahaa M
authors.initials: BM
authors.lastname: Fadel
authors.forename: Bandar
authors.initials: B
authors.lastname: Al-Amro
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Admawi
authors.forename: Hani
authors.initials: H
authors.lastname: Sergani
authors.forename: Bahaaldin
authors.initials: B
authors.lastname: Alsoufi
authors.forename: Valeria
authors.initials: V
authors.lastname: Pergola
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Salvo
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D023921:Coronary Stenosis / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis*
keywords: echocardiography; myocardial ischemia; myocardial strain; postsystolic thickening